Healthcare Provider Details

I. General information

NPI: 1043379241
Provider Name (Legal Business Name): TERESA ANNE KURTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 04/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 LEMAY FERRY RD STE 120
SAINT LOUIS MO
63129-1526
US

IV. Provider business mailing address

PO BOX 7412065
CHICAGO IL
60674-2065
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-3320
  • Fax: 314-849-7766
Mailing address:
  • Phone: 314-849-3320
  • Fax: 314-849-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2010017705
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: